{OVERALL_HEADER}<table width="780" border="0" align="center" cellpadding="0" cellspacing="0">
  <tr>
    <td valign="top"><br>
      <form action="signup.php" method="post" enctype="multipart/form-data" name="form1">
        <table width="500" border="0" cellspacing="0" cellpadding="0">
          <tr>
            <td valign="top" style="padding-top:5px;"><strong>{LANG_USERNAME}</strong></td>
          </tr>
          <tr>
            <td><input name="username" type="text" id="username" style="width:200px;" onchange="changeuser(this,'avail');" onkeypress="changeuser(this,'avail');" onkeyUp="changeuser(this,'avail');" value="{USERNAME_FIELD}" maxlength="16">
                <br>
                <input type="button" name="avail" id="avail" value="{LANG_CHECKAVAIL}" onclick="checkavail('username','provider');" style="width:200px;" disabled>
                <br>
                <span id="availres"></span> <br>
                <span class="error">{USERNAME_ERROR}</span></td>
          </tr>
          <tr>
            <td valign="top" style="padding-top:5px;"><strong>{LANG_PASSWORD}</strong></td>
          </tr>
          <tr>
            <td><input name="password" type="password" id="password" style="width:200px;" maxlength="16"></td>
          </tr>
          <tr>
            <td valign="top" style="padding-top:5px;"><strong>{LANG_CONPASS}</strong></td>
          </tr>
          <tr>
            <td><input name="password2" type="password" id="password2" style="width:200px;" maxlength="16">
                <br>
                <span class="error">{PASSWORD_ERROR}</span></td>
          </tr>
          <tr>
            <td>&nbsp;</td>
          </tr>
          <tr>
            <td valign="top" style="padding-top:5px;"><strong>{LANG_EMAILAD}</strong></td>
          </tr>
          <tr>
            <td><input name="email" type="text" id="email" style="width:200px;" value="{EMAIL_FIELD}" maxlength="255">
                <br>
                <span class="error">{EMAIL_ERROR}</span></td>
          </tr>
          <tr>
            <td>&nbsp;</td>
          </tr>
          <tr>
            <td valign="top" style="padding-top:5px;"><strong>{LANG_NAMECOM}</strong></td>
          </tr>
          <tr>
            <td><input name="name" type="text" id="name" style="width:200px;" value="{NAME_FIELD}" maxlength="255">
                <br>
                <span class="error">{NAME_ERROR}</span></td>
          </tr>
          <tr>
            <td>&nbsp;</td>
          </tr>
          IF("{PAY_TYPE}"=="1"){<tr>
            <td valign="top" style="padding-top:5px;"><strong>{LANG_PAYPALADDR}</strong></td>
          </tr>
          <tr>
            <td><input name="paypal" type="text" id="paypal" style="width:200px;" value="{PAYPAL_FIELD}" maxlength="255"><br>
                <span class="error">{PAYPAL_ERROR}</span></td>
          </tr>
          <tr>
            <td>&nbsp;</td>
          </tr>{:IF}
          <tr>
            <td valign="top" style="padding-top:5px;"><strong>{LANG_AVGHOURLY}</strong></td>
          </tr>
          <tr>
            <td>{CURRENCY_SIGN}<input name="rate" type="text" size="5" value="{RATE_FIELD}">/{LANG_HOUR}</td>
          </tr>
          <tr>
            <td>&nbsp;</td>
          </tr>
			<tr>
            <td valign="top" style="padding-top:5px;"><strong>{LANG_AREAOF}</strong></td>
          </tr>
          <tr>
            <td>{LOOP: JOBTYPE}
      IF("{JOBTYPE.parent_id}"!="0"){&nbsp; {:IF}
      IF("{JOBTYPE.catcount}"=="0"){<input type="checkbox" name="jobtype[{JOBTYPE.id}]" value="{JOBTYPE.id}" {JOBTYPE.selected}>{JOBTYPE.title}<br>{:IF}
      IF("{JOBTYPE.catcount}"!="0"){<strong>{JOBTYPE.title}</strong><br>{:IF}
      {/LOOP: JOBTYPE}</td>
          </tr>
          <tr>
            <td>&nbsp;</td>
          </tr>
			<tr>
            <td valign="top" style="padding-top:5px;"><strong>{LANG_NOTIFICATION}</strong></td>
          </tr>
          <tr>
            <td>
              <input name="notify" type="checkbox" id="notify" value="1">
{LANG_NOTIFYEMAIL}</td>
          </tr>
          <tr>
            <td>&nbsp;</td>
          </tr>
			<tr>
            <td valign="top" style="padding-top:5px;"><strong>{LANG_YOURPROFILE}</strong></td>
          </tr>
          <tr>
            <td>
              <textarea name="profile" cols="50" rows="7" id="textarea"></textarea></td>
          </tr>
          <tr>
            <td>&nbsp;</td>
          </tr>
			<tr>
            <td valign="top" style="padding-top:5px;"><strong>{LANG_PICTURE} (optional)</strong></td>
          </tr>
          <tr>
            <td><input type="file" name="picture"></td>
          </tr>
          <tr>
            <td>&nbsp;</td>
          </tr>
        {LOOP: CUSTOMFIELDS}
        <tr>
          <td valign="top" style="padding-top:5px;"><strong>{CUSTOMFIELDS.title}</strong></td>
        </tr>
        <tr>
          <td>
          IF("{CUSTOMFIELDS.type}"=="text"){<input name="custom[{CUSTOMFIELDS.id}]" type="text" id="custom[{CUSTOMFIELDS.id}]" size="30" maxlength="{CUSTOMFIELDS.maxlength}" value="{CUSTOMFIELDS.default}">{:IF}
          IF("{CUSTOMFIELDS.type}"=="select"){{CUSTOMFIELDS.selectbox}{:IF}
          </td>
        </tr>
          <tr>
            <td>&nbsp;</td>
          </tr>
        {/LOOP: CUSTOMFIELDS}
          <tr>
            <td valign="top"><strong>{LANG_SECURITY}</strong></td>
          </tr>
          <tr>
            <td><table border="0" cellpadding="0" cellspacing="0">
        IF("{SECURITY_CODE}"=="1"){
        <tr>
          <td height="55" valign="top"><img src="seccode.php"></td>
        </tr>
        <tr>
          <td><input name="security_code" type="text" id="security_code"></td>
        </tr>
        <tr>
          <td>{LANG_TYPESEC}<br>
              <span class="error">{SECURITY_ERROR}</span></td>
        </tr>
        {:IF}
            </table></td>
          </tr>
          <tr>
            <td>&nbsp;</td>
          </tr>
          <tr>
            <td><table  border="0" cellpadding="0" cellspacing="0">
                <tr>
                  <td><input name="agree" type="checkbox" value="1"></td>
                <td>{LANG_IAGREE} <a href="#" onClick="window.open('{SITE_URL}html.php?id=terms&basic=1','terms','width=300,height=500,scrollbars=yes')">{LANG_TANDC}</a> {LANG_FORUSING} {SITE_TITLE}<br>
                    <span class="error">{AGREE_ERROR}</span></td>
                </tr>
            </table></td>
          </tr>
          <tr>
            <td>&nbsp;</td>
          </tr>
          <tr>
            <td><span class="normal">
              <input name="type" type="hidden" id="type" value="provider">
              </span>
                <input type="submit" name="Submit" value="{LANG_SIGNUP}"></td>
          </tr>
        </table>
      </form>
      <br></td>
  </tr>
</table>
{OVERALL_FOOTER}